Introduction
The cornerstone of diabetes mellitus type 2 is a problem with how the body regulates blood glucose levels and uses it as an energy source. Considering how many individuals suffer from this condition, this is one of the significant problems in contemporary healthcare. In this paper, a single patient’s situation will be discussed, along with relevant medications and potential interventions and nursing care plans.
Basic Conditioning Factors
Mr. Allen smith is 81 yrs. old male who is a long-term SCI resident. He has the ability to respond to pressure-related discomfort. The patient is alert and oriented. He is slow to respond at times and has difficulty finding his words or expressing his feelings. The patient has a foley catheter in place draining yellow, clear, urine. The patient is aware of his own limitations and understands to call for help when needed. The patient is not compliant with turning every two hours and sleeps well through the night. He has several preferences, such as bed side rails up to four, pillow offload of the heels. The patient has pain in the lower extremities and weak limbs. When it comes to dependencies, the patient is totally dependent on bathing, dressing, and toileting. He also requires assistance in mobility but is independent in eating. There is a regular diet with a usual food intake prescribed.
Expected Signs and Symptoms of Primary or Admission Medical Diagnosis
A problem in type 2 diabetes affects how the body manages and utilizes glucose and sugar as fuel. Too much sugar is flowing in the blood because of this chronic, long-lasting illness. High blood sugar levels can ultimately result in issues with the immunological, neurological, and circulatory systems. Approximately 90% of all patients with diabetes in the US, Canada, and Europe have type 2 diabetes (Galicia-Garcia et al., 2020). Because it is a chronic condition, blood sugar levels must be closely monitored and treated throughout one’s lifetime. This includes modifying one’s lifestyle, practicing self-care, and occasionally taking medicine. These therapies help maintain stable blood sugar levels and reduce the likelihood of problems.
Many individuals with type 2 diabetes may not initially exhibit any symptoms, and the condition may continue untreated for many years. Extreme thirst, increased urination, fatigue, and slow healing cuts may be some of them (Galicia-Garcia et al., 2022). Diabetes problems over time may result in additional symptoms. Obesity, physical inactivity, age, and a family history of diabetes are among the several risk factors for getting the disease (over 55) (Sauma et al., 2022). Although medicines are frequently needed, lifestyle modifications are the primary focus of interventions for type 2 diabetes diagnosis. This also entails receiving professional team-assisted training in managing and monitoring diabetes.
Health Deviations
Diabetes mellitus type 2 can result in a variety of acute and chronic problems. It is a key cause of cardiovascular disease (CVD), blindness, renal failure, and lower limb amputation is diabetes mellitus. Hypoglycemia, diabetic ketoacidosis, hyperglycemia with a hyperosmolar condition, and hyperglycemia with diabetic coma are examples of acute consequences (Sauma et al., 2022). In this case, the key health deviation of the patient is hypoglycemia. A fall in plasma glucose concentration that might result in symptoms or indicators including changes in mental state and/or activation of the sympathetic nervous system is known as hypoglycemia (Galicia-Garcia et al., 2020). The processes regulating glucose homeostasis are often disturbed to cause this disease. When a diabetic patient has hypoglycemia, insulin injection, meal skipping, or insulin overdose are the most frequent causes.
Nursing Diagnosis
Within the information given, it is vital to give priority to nursing diagnosis. Two diagnoses can be made – the risk for unstable blood glucose level and excessive fatigue. Insufficient blood glucose monitoring, as well as demonstrated by treatment and prescription guidelines for diabetes, increases the risk of unstable blood glucose levels. The goal would be to identify the important factors influencing glucose change and work toward maintaining an appropriate glucose range. The second diagnosis, fatigue, resulted from altered body chemistry, such as low insulin levels and decreased metabolic energy generation, as shown by the inability to carry out regular daily activities and attention deficits. The patient will be able to vocally express more energy and show signs of being better equipped to carry out desired tasks.
Plan of Care
Explaining to the patient the significance of weight reduction for obese and diabetic individuals will be the first diagnostic intervention. Losing weight is essential for treating diabetes. A 5–10% reduction in body weight can reduce or perhaps get rid of the requirement for medication while also considerably lowering blood sugar levels. Additionally, it is vital to convey to the patient the significance of the proper timing or content of meals. Therefore, eating consistently throughout the day lessens the stress on the pancreas.
It is vital to alternate times of activity with rest and uninterrupted sleep during the second diagnostic intervention. This strategy seeks to prevent needless attrition. Additionally, it is crucial to guarantee the patient’s safety and comfort while exercising. Diabetes patients must engage in physical activity, but the nurse or other healthcare professional must also look for the patient’s safety and well-being.
Medications
Metformin
Metformin is commonly used to treat gestational diabetes and type 2 diabetes. When blood sugar levels are excessively high, using metformin alone, together with a specific class of oral diabetes medication known as a sulfonylurea or insulin, will help decrease them and improve how to use food for energy (LaMoia & Shulman, 2021). Although enough research on the association between age and metformin effects in the geriatric population has not been done, difficulties unique to the elderly are not anticipated to impede the efficacy of metformin in this population. However, older people are more prone to experience age-related renal issues, thus metformin users may need to exercise caution.
Metformin overuse may occasionally result in lactic acidosis. The signs and symptoms of it appear suddenly, and frequently accompany other major health issues that are unrelated to the medicine, such as a heart attack or renal failure (LaMoia & Shulman, 2021). Abdominal pain, a loss of appetite, diarrhea, and quick or shallow breathing are all signs of lactic acidosis. Metformin usage for a long period of time, particularly in those who take larger dosages, can also result in a reduction in vitamin B12 levels (LaMoia & Shulman, 2021). When such symptoms are evident, it will be recommended that the patient will stop taking this medication.
Insulin NPH
Neutral Protamine Hagedorn, often known as Insulin NPH, is a medication used to treat diabetes, a condition that has a high risk of coronary heart disease. The class of intermediate-acting insulins includes insulin NPH, an isophane suspension of human insulin (Machry et al., 2021). The liver, adipose tissue, and skeletal muscle all see an increase in cellular glucose absorption as a result. It serves as a substitute for baseline insulin and increases the production of fatty acids for the synthesis of lipoproteins and hepatic glycogen (Sauma et al., 2022). The main objective of managing diabetes is to avoid long-term consequences. Improving and maintaining glycemic control over time is an essential strategy for achieving this objective. Due to the disease’s progressive nature, which necessitates prompt treatment optimization and typically results in insulin therapy, this is a difficult assignment.
The risk of hypoglycemia is sometimes increased with NPH insulin. Hypoglycemia is thought to be caused by inadequate resuspension, which also contributes to the substantial diurnal variability in the pharmacodynamic and pharmacokinetic profile of NPH insulin (Machry et al., 2021). NPH is not a good candidate for a basal insulin. After subcutaneous injection, it exhibits significant diversity in both its absorption and effect (Sauma et al., 2022). This condition produces bouts of hypoglycemia and variations in blood glucose regulation. Because of this, meticulous observation is necessary, particularly fasting blood glucose levels.
Hydrochlorothiazide
High blood pressure is treated with hydrochlorothiazide alone or in combination with other medications (hypertension). In addition, fluid retention brought on by steroid or hormone therapy, severe liver illness, renal disease, congestive heart failure, and other medical conditions are treated with hydrochlorothiazide (Roulette et al., 2021). By boosting urine flow, it is utilized to assist in decreasing the body’s water content. The distal convoluted tubules are the site of hydrochlorothiazide’s action, which prevents sodium chloride cotransport (Roulette et al., 2021). Although the blood pressure is reduced due to the diuretic effect of this action, potassium is also lost in the urine.
For many people, hydrochlorothiazide remains the medication of choice for treating hypertension. The medication is widely applicable and does not interfere when taken with other antihypertensive medications. The pharmacological effects start to take action about two hours after administration, peak at four hours and linger for about six to twelve hours (Roulette et al., 2021). The majority of hydrochlorothiazide is eliminated in the urine unaltered since it is not digested. The medication lowers blood pressure when it is used acutely by boosting diuresis and lowering plasma volume (Roulette et al., 2021). Hydrochlorothiazide, however, seems to lower blood pressure by lowering peripheral resistance after prolonged use.
As with any medication, hydrochlorothiazide has a number of potential adverse effects. Skin cancer, electrolyte and fluid imbalances, such as hypokalemia, hyponatremia, hypercalcemia, and/or hypomagnesemia, may all be made more likely by this medication (Sauma et al., 2022). Acute transitory myopia and acute angle-closure glaucoma are additional side effects that might develop hours or weeks after taking the medication (Roulette et al., 2021). Although it might not be as efficient as some other thiazide diuretics, hydrochlorothiazide has been the most often prescribed thiazide medication for the treatment of hypertension.
Labs
Result
Range:
WBC 8.22
4-00 – 11.00
RBC
3.52
4.33 – 5.63
HEMOGLOBIN 10.6
13.5 – 17.0
HEMATOCRIT 33.3
39.0 – 50.0
RDW – CV 13.7
11.7 – 15.2
RDW – SD 47.2
36.8 – 49.6
PLATELET 212
150 – 400
MPV
9.2
9.2 – 12.5
Glucometer 92mg/dL
60 – 100
Pt: Vitals: BP – 120/69
Temperature: 97.8
Pulse: 87
Respirations: 18
Height: 78 inches
Conclusion
Diabetes mellitus type 2 should be diagnosed and treated by a multidisciplinary team. Patients should also be told about lifestyle modifications that can reduce blood sugar levels. All patients who are obese should be urged to lose weight, exercise, and adopt a healthy diet. All diabetic patients should be encouraged by their primary care physician and a diabetic nurse to give up smoking and abstain from alcohol. Diabetes mellitus complications are dangerous to health and life and significantly lower quality of life. In the case presented, the necessary nursing interventions were described as well as a proposed plan of care to ensure the best treatment for the patient, taking into account his individual complications.
References
Galicia-Garcia, U., Benito-Vicente, A., Jabari, S., Larrea-Seal, A., Siddiqi, H., Uribe, K. B. & Martin, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275-6299. Web.
LaMoia, T. E., & Shulman, G. I. (2021). Cellular and molecular mechanisms of metformin action. Endocrine Reviews, 42(1), 77-96. Web.
Machry, R. V., Cipriani, G. F., Pedroso, H. U., Nunes, R. R., Pires, T. L. S., Ferreira, R. & Rodrigues, T. C. (2021). Pens versus syringes to deliver insulin among elderly patients with type 2 diabetes: a randomized controlled clinical trial. Diabetology & Metabolic Syndrome, 13(1), 1-9. Web.
Roulette, J., Yi, H., Pottegard, A., Nirantharakumar, K., & Azoulay, L. (2021). Use of hydrochlorothiazide and risk of melanoma and nonmelanoma skin cancer. Drug Safety, 44(2), 245-254. Web.
Sauma, A. W., Sriagustini, I., Fitriani, S., Hidayani, W. R., & Malabanan, L. M. (2022). The Analysis of Factors Influencing Hypertension on Elderly: A Literature Study. Journal of Public Health Sciences, 1(01), 16-29. Web.